Erlotinib-related skin toxicities: treatment strategies in patients with metastatic non-small cell lung cancer

J Am Acad Dermatol. 2013 Sep;69(3):463-72. doi: 10.1016/j.jaad.2013.02.025. Epub 2013 Apr 17.


Skin toxicities are the most common side effects associated with the epidermal growth factor receptor inhibitor erlotinib, occurring in most patients receiving the drug. Clinical trials evaluating erlotinib for the treatment of non-small cell lung cancer have reported a range of skin disorders, the most common being acneiform rash, xeroderma (dry skin), pruritus, and paronychia. Although in the majority of cases these effects are mild and transient, they can have a considerable impact on a patient's quality of life and, if particularly severe and persistent, may necessitate treatment interruption or cessation and compromise treatment outcome. This coupled with recent evidence to suggest a positive correlation between the incidence and severity of rash and clinical outcome among erlotinib-treated patients with advanced or metastatic non-small cell lung cancer highlights the importance of adequately managing epidermal growth factor receptor inhibitor--related skin disorders. Clear treatment strategies are therefore necessary to ensure the prevention and optimal management of erlotinib-related skin toxicities thereby enabling patients to continue erlotinib treatment. In this review we present a practical approach for the treatment of erlotinib-related cutaneous side effects in Japanese patients with advanced non-small cell lung cancer providing details of specific treatment interventions, according to symptom severity, for each of the common skin disorders. In addition, the importance of preventive skin care measures--namely maintaining cleanliness, moisturization, and protection from external stimuli--in preventing the development of serious skin disorders is discussed and guidelines for the practice of proper skin care are presented.

Keywords: ADL; AEs; BSA; CI; CRC; EGFR; FTUs; HR; Japanese patients; NSCLC; OS; STEPP; Skin Toxicity Evaluation Protocol with Panitumumab; UV; acneiform rash; activities of daily living; adverse events; body surface area; colorectal cancer; confidence interval; cutaneous side effects; epidermal growth factor receptor; epidermal growth factor receptor inhibitor; erlotinib; fingertip units; hazard ratio; non-small cell lung cancer; overall survival; prevention; skin toxicities; ultraviolet.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acneiform Eruptions / chemically induced
  • Acneiform Eruptions / drug therapy
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Drug Eruptions / drug therapy*
  • Drug Eruptions / etiology
  • Drug Eruptions / prevention & control
  • Erlotinib Hydrochloride
  • Humans
  • Ichthyosis / chemically induced
  • Ichthyosis / drug therapy
  • Lung Neoplasms / drug therapy*
  • Paronychia / chemically induced
  • Paronychia / drug therapy
  • Patient Education as Topic
  • Pruritus / chemically induced
  • Pruritus / drug therapy
  • Quinazolines / adverse effects*
  • Quinazolines / therapeutic use


  • Antineoplastic Agents
  • Quinazolines
  • Erlotinib Hydrochloride